颈淋巴结转移临床处理概念上的变化─—分区性颈清扫术

分区性颈清扫术（selectiveneckdissection，SND）是根据头颈部特定部位肿瘤颈淋巴结转移规律而设定的非全颈性清扫，手术范围缩小而不影响根治性。有利于保留患者外观和术后功能。SND目前主要应用于临床颈淋巴结阴性（cN0）和部分阳性（cN1）的上呼吸消化道鳞癌患者，有多个淋巴结转移或术后病理提示淋巴结有包膜外侵犯的患者应配合应用放疗。不同术式的分区性颈清扫适应于不同原发灶的转移。治疗结果显示SND治疗后的效果及手术区域颈部淋巴结复发率与改良根治性颈清扫相似。

Selective neck dissection: A conceptual approach to the neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts

Selective neck dissectin (SND) is predicated on the relative risk formetastasis to specified cervical lymphatic basins for a given primary head and neck tumor. This type of dissection,which includes dissection of only the lymph nodes at risk,isoncologically sound and much better from a functional and cosmetic point of view thanthe radical technique. SND is mainly applied for elective treatment of the No neck andfor therapeutic treatment of the selected N, neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. However,if the postoperative histological reports revealed multiple nodes involvement or extracapsular extension,an adjunctiveradiotherapy is recommended. The types of SND should be carefully chosen and appropriately performed by the experienced surgeon according to the lesions at different primary sites. It is accepted that SND of anatomically appropriate levels is as effective asmodified radical neck dissection for treatment of No and N, neck in patient with squamous cell carcinoma of the uper respiratory and digestive tracts.